NPI 1083873905

John Allan Clayton Fulling, IDC

Practitioner Independent Duty Corpsman Great Lakes, IL

Practice location

Address: 2410 Sampson St Fisher Bmc #237, Great Lakes, IL 60088
Phone: (847) 688-5556
Fax: (847) 688-2512
Mailing address: 2524 N Poplar St, Waukegan, IL 60087-3127

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1083873905
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 Jun 2008
Record last updated: 5 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.